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DOI: 10.1055/s-0042-1750836
Removal Rate of the Tomofix® System after High Tibial Osteotomy is Higher Than Reported[*]
Article in several languages: português | English Financial Support The authors declare they have received no financial support from public, commercial, or non-profit sources.Abstract
Objective Medial open wedge high tibial osteotomy (MOWHTO) significantly relieves pain in the medial joint line in medial compartment osteoarthritis of the knee. But some patients complain of pain over the pes anserinus even 1 year after the osteotomy, which may require implant removal for relief. This study aims to define the implant removal rate after MOWHTO due to pain over the pes anserinus.
Methods One hundred and three knees of 72 patients who underwent MOWHTO for medial compartment osteoarthritis between 2010 and 2018 were enrolled in the study. Knee injury and osteoarthritis outcome score (KOOS), Oxford knee score (OKS), and visual analogue score (VAS) were assessed for pain in the medial knee joint line (VAS-MJ) preoperatively, 12 months postoperatively, and yearly thereafter; adding VAS for pain over the pes anserinus (VAS-PA). Patients with VAS-PA ≥ 40 and adequate bony consolidation after 12 months were recommended implant removal.
Results Thirty-three (45.8%) of the patients were male and 39 (54.2%) were female. The mean age was 49.4 ± 8.0 and the mean body mass index was 27.0 ± 2.9. The Tomofix medial tibial plate-screw system (DePuy Synthes, Raynham, MA, USA) was used in all cases. Three (2.8%) cases with delayed union requiring revision were excluded. The KOOS, OKS, and VAS-MJ significantly improved 12 months after MOWHTO. The mean VAS-PA was 38.3 ± 23.9. Implant removal for pain relief was needed in 65 (63.1%) of the103 knees. The mean VAS-PA decreased to 4.5 ± 5.6 3 months after implant removal (p < 0.0001).
Conclusion Over 60% of the patients may need implant removal to relieve pain over the pes anserinus after MOWHTO. Candidates for MOWHTO should be informed about this complication and its solution.
Keywords
bone plates - bone transplantation - device removal - osteotomy - surgical wound infection - tibia* Work developed in the Beyzadeoglu Clinic, Orthopaedics & Traumatology, Istanbul/Turkey
Publication History
Received: 02 March 2022
Accepted: 28 April 2022
Article published online:
28 June 2022
© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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Referências
- 1 Pehlivanoglu T, Yildirim K, Beyzadeoglu T. High Tibial Osteotomy. In: Nikolopoulos DD, Safos GK, Michos J, eds. Tibia Pathology and Fractures. London: IntechOpen; 2020: 109-131
- 2 Roberson TA, Momaya AM, Adams K, Long CD, Tokish JM, Wyland DJ. High Tibial Osteotomy Performed With All-PEEK Implants Demonstrates Similar Outcomes but Less Hardware Removal at Minimum 2-Year Follow-up Compared With Metal Plates. Orthop J Sports Med 2018; 6 (03) 2325967117749584
- 3 Woodacre T, Ricketts M, Evans JT. et al. Complications associated with opening wedge high tibial osteotomy–A review of the literature and of 15 years of experience. Knee 2016; 23 (02) 276-282
- 4 Hevesi M, Macalena JA, Wu IT. et al. High tibial osteotomy with modern PEEK implants is safe and leads to lower hardware removal rates when compared to conventional metal fixation: a multi-center comparison study. Knee Surg Sports Traumatol Arthrosc 2019; 27 (04) 1280-1290
- 5 Brouwer RW, Bierma-Zeinstra SM, van Raaij TM, Verhaar JA. Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. J Bone Joint Surg Br 2006; 88 (11) 1454-1459
- 6 Niemeyer P, Koestler W, Kaehny C. et al. Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee. Arthroscopy 2008; 24 (07) 796-804
- 7 Niemeyer P, Schmal H, Hauschild O, von Heyden J, Südkamp NP, Köstler W. Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 2010; 26 (12) 1607-1616
- 8 Darees M, Putman S, Brosset T, Roumazeille T, Pasquier G, Migaud H. Opening-wedge high tibial osteotomy performed with locking plate fixation (TomoFix) and early weight-bearing but without filling the defect. A concise follow-up note of 48 cases at 10 years' follow-up. Orthop Traumatol Surg Res 2018; 104 (04) 477-480
- 9 Sidhu R, Moatshe G, Firth A, Litchfield R, Getgood A. Low rates of serious complications but high rates of hardware removal after high tibial osteotomy with Tomofix locking plate. Knee Surg Sports Traumatol Arthrosc 2021; 29 (10) 3361-3367